04.02 Anemia in Pregnancy

Overview

A decreased oxygen carrying capacity of the blood

Nursing Points

General

  1. In pregnancy, this is typically due to an insufficient amount of iron
  2. There is an increased need for iron in pregnant women due to the growing fetus and placenta, and increased circulating blood volume
  3. Without enough RBCs oxygen can’t get to the patient’s tissues as well nor to the baby as effectively

Assessment

  1. Symptoms
    1. Pale
    2. Fatigue
    3. Cold
    4. Headaches
    5. Lightheadedness
  2. CBC’s must be monitored frequently (q 2 weeks) to watch H/H
  3. Also relative anemia (low Hct) due to increased circulating plasma volume compared with increase in red blood cell volume
  4. Risk for intrapartum and postpartum hemorrhage
    1. Blood transfusions may be needed during delivery

Therapeutic Management

  1. Iron and folic acid supplements may be ordered; encourage dietary sources
    1. Nutritional education is important
    2. Iron supplements best absorbed between meals, with a Vitamin C source, but not with any milk or tea products
  2. Iron transfusions
  3. Oxytocin can be given for postpartum hemorrhage
    1. Drug of choice
      1. Causes uterus to contract quicker and stronger, therefore decrease bleeding.  Placenta detaches and creates essentially a wound within the uterus. We need to it to contract and get smaller ASAP to decrease this bleeding risk.

Nursing Concepts

  1. Clotting
  2. Oxygenation

Patient Education

  1. Take iron supplements as directed
  2. Report heavy bleeding after delivery
  3. Frequent rest periods due to s/s fatigue

Reference Links

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Video Transcript

In this lesson I will explain anemia in pregnancy and your role for caring for this patient.

Anemia is defined as decreased oxygen carrying capacity of the blood. Let’s talk about the causes. In pregnancy, this usually because there is an insufficient amount of iron. So typically iron deficiency anemia. There is a greater need in pregnancy for iron because of the growing fetus and placenta and the increased circulating blood volume. Remember oxygen binds to the red blood cells to travel the body so if there is not enough iron to make red blood cells then oxygen can’t get to the patient’s tissues nor to the baby as effectively. In this image you can see the red blood cells traveling and they will carry the oxygen. If we lose some of these red blood cells then we lose the ability to carry oxygen.

Some of our symptoms for anemia are pale, fatigue, cold, headaches, and lightheadedness. In this image you can see some additional symptoms listed for each system. We have shortness of breath because we are low on oxygen and muscular system is weak because oxygen isn’t getting perfused to the tissues as well. We see the heart rate increased because the body is desperately trying to pump and oxygenate quickly. We might be required to monitor CBC’s frequently to watch H/H. There is also what we call relative anemia because of a low Hematocrit because remember there is an increased circulating plasma volume compared with increase in red blood cell volume. Sometimes the patients might even need iron infusions if this is the cause. These patients can be at a greater risk for intrapartum and postpartum hemorrhage so for that reason blood transfusions may be needed.

Now let’s look at therapeutic management for our anemic person. Iron and folic acid supplements may be ordered for the patient depending on the type of anemia. encourage dietary sources Transfusions might be needed and this could be iron transfusions or blood. These patients are at risk for hemorrhage especially right after delivery so oxytocin can be given and this is the drug of choice, Oxytocin causes the uterus to contract quicker and stronger which will decrease bleeding.

Clotting and oxygenation are our nursing concepts for a patient with anemia. We need red blood cells to carry the oxygen to the tissues and fetus and we also need the body to clot rapidly after delivery so the patient does not lose more blood.

Patients should be educated on taking frequent rest periods due to symptoms of fatigue. The patients should be educated to take iron supplements as directed. Vitamin C is important to remember. This is usually thrown in with those nutritional questions and vitamin C. Iron supplements are best absorbed between meals and with a Vitamin C source. No milk or tea products. Vitamin C will help the absorption of iron. They should also report any heavy bleeding after delivery so that we can quickly address it.
Our key points to pull it all together for you are that iron is our most common anemia in pregnancy. Iron is needed for red blood cell production. Red blood cells carry our oxygen so if we don’t have enough then we don’t have enough oxygen. Diet changes should include foods high in iron and vitamin C to help absorption. Supplements can help and should be taken between meals for best absorption. Iron transfusions, and blood transfusions might be necessary and it is important to monitor bleeding post delivery because the patient is losing more red blood cells are lost.

Make sure you check out the resources attached to this lesson and study foods that are good source of iron. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 7

A nurse is providing medication instructions for a pregnant client that has been prescribed ferrous sulfate for her iron deficiency anemia. What information should be included in the instructions?

  • Question 2 of 7

A nurse is educating a pregnant client on some diet options to improve her iron deficiency anemia. What the most appropriate selection for this client?

  • Question 3 of 7

A nurse is caring for a pregnant client who has been diagnosed with anemia. What management plan should the nurse anticipate?

  • Question 4 of 7

The nurse is caring for a woman who is a carrier for G6PD deficiency in the clinic. The client’s spouse does not have the deficiency. How does the nurse counsel this client regarding future pregnancies?

  • Question 5 of 7

A nurse is educating a pregnant client on the importance of taking prescribed ferrous sulfate for her anemia. What statement by the nurse is the most appropriate?

  • Question 6 of 7

Your patient is here to deliver her 2nd child. She is at 39 weeks gestation and has been anemic during the majority of her pregnancy. Which of the following is your biggest concern for this patient?

  • Question 7 of 7

A nurse is assessing a client who is 30-weeks pregnant and diagnosed with iron-deficiency anemia. What symptoms should the nurse expect to find?

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